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Dealing with early side effects

During the first few weeks of your recovery, while you are still in hospital, you’re likely to experience some side effects from your treatment. Most of these early problems come from the chemotherapy and/or radiotherapy you had before your transplant but other concerns, such as GvHD, could also develop. Your medical team will be monitoring you every day and will treat any of the following side effects you might have:

It’s common to feel sick and be sick after your transplant because of your treatment, medication, a possible infection or GvHD. Nausea normally only lasts a week or two for most people. If you struggle with nausea for longer, talk to your transplant team because they might need to change your medication.

Possible treatments – Anti-emetic drugs stop you feeling nauseous. They may be given as tablets, through your central line or as a patch on your skin.

What might help – It’s important to replace lost fluids and stay hydrated. Isotonic drinks or sachets of oral rehydration salts replace lost salts and sugars (electrolytes) that your cells need to stay healthy.

As with nausea, diarrhoea can have many different causes (including GvHD). If diarrhoea occurs for a long time, it can affect how you absorb vitamins and minerals from food, which can lead to weight loss. It’s important to tell your doctor or nurse if you are having diarrhoea.

Possible treatments – Anti-diarrhoeal medication can help but your medical team will be keen to identify the cause of the problem. They might suggest changes to your diet, eating habits or medications.

What might help – Eating plain foods that are easier to digest and keeping hydrated with plenty of fluids.

Chemotherapy damages the cells in the mucosal lining of your mouth. The skin can break down, which can cause painful ulcers to form inside your mouth and throat.

Ulcers may also form further down your digestive tract, which can cause discomfort and make it difficult to eat certain foods. This normally occurs about a week after treatment and will clear up in a week or two.

Possible treatments – Painkillers and sprays or gels that keep your mouth moist. If you find regular painkillers are not working well enough, your doctor might recommend a continuous infusion of a strong painkiller, such as morphine, given through a small pump into the tissue just under the skin. You will also be encouraged to practise good oral hygiene and use mouthwash. A toothbrush with softer bristles could be more suitable if you have sore gums.

What might help – It will probably be easier to eat softer foods like mashed potato and soup. Ice lollies can help to numb any gum pain and are a good way of taking on extra fluid.

‘The mouth ulcers, I think, were the worst part of treatment. At times it was so difficult that I really didn't want to eat anything. Even water tasted strange or any sort of juice.'Sue, who had a transplant in 2011 - you can hear her talk about her experience with diet in our patient insight video here

Food can often taste different after chemotherapy and you might find that you don’t have the same appetite for food as you did before. If you also experience prolonged sickness and diarrhoea, it could stop you getting the nutrients and energy needed for your recovery.

‘I didn't have much of an appetite at all. In the first two weeks I couldn't actually eat because I was feeling so sick. So I just had liquid drinks but gradually my appetite improved.'David, who had a transplant in 2014 - you can hear him talk about his experience with diet in our patient insight video here

Possible treatments – Your weight will be monitored by your medical team regularly. You may see a dietician who can advise on how to increase your nutritional intake and give you supplement drinks or soups. However, if problems persist, you may need to be fed via a feeding tube. There are two possible types that provide nutrition in slightly different ways.

Enteral nutrition – When nutrition is passed through a small tube directly into your stomach. This will most likely be a nasogastric tube, inserted through your nose and down your throat. It will probably stay in for a few weeks or until your condition improves. These tubes help patients who have sore mouths or find swallowing difficult.

Parenteral nutrition – Nutrition is delivered directly into your bloodstream through your central line. It will be administered by your nurse and then your line will be cleaned to reduce the risk of infection. This option is often used if you experience severe GvHD in your digestive tract or if it’s very difficult to keep any food or drink down.

When we talk about fatigue, we don’t just mean feeling tired after hard work. Fatigue is when you find it difficult to concentrate and have no energy, even after lots of rest and a good night’s sleep.

Fatigue can be a short-term effect of your treatment that improves after a few months, but some patients experience it more than a year after their transplant. As surprising as it sounds, gentle exercise has been shown to help reduce treatment-related fatigue and improve your strength and energy levels. You will really feel the benefit of doing something, no matter how small.

‘It's going to the end of the road to get the newspaper, and having to sit down halfway home, and then that wiping you out for the rest of the day.'David, who had a transplant in 2014 - you can hear about his experience with fatigue in our patient insight video here

Possible treatments – Your hospital’s physiotherapist can set up a programme of lite exercises and stretches for you to do daily.

What might help – Keep things in balance, as your energy levels are likely to go up and down. The secret is to not overdo it on a good day but, even more importantly, still try to do something on what might feel like a bad day.

In the few weeks after your transplant, your new immune system is still developing. This means that there is a greater risk of picking up an infection. Your medical team will look out for the early signs of an infection, such as a raised temperature, so that you are treated as soon as possible.

Possible treatments – You will be given a course of antibiotics, anti-fungal or anti-viral drugs depending on the cause of your infection.

What might help – The protective isolation ward you are staying in will have measures in place to reduce the risk of infection. This includes air filters, alcohol gel hand washes, daily bedding changes and regular cleaning.